New World Villa North

Type of visit: Required - 1 Year

Licensing Program Analysts (LPAs) Angelica Boyles and Patrice Bazemore conducted an unannounced Required Annual Inspection. The facility file was reviewed prior to the visit. LPAs were welcomed by, identified themselves to, and discussed the purpose of the visit with Caregiver Mariaelena Bautista. LPAs, accompanied by caregiver, toured the interior and exterior of the facility, and inspected each room. Pathways were free of obstruction and slip hazards. Resident bedrooms contained the required furnishings. Doors, windows and screens, toilets, and showers were in working order. Extra linens and hygiene supplies were present. The facility had sufficient space and equipment to facilitate dining, laundry, visitation, meetings, and resident activities. LPAs observed Resident #1 (R1) laying in bed with two chairs placed in front of her bed. Staff reported the chairs are placed there to prevent her from getting up and falling. There was at least 2 days of perishable food, and at least 7 days non-perishable food present, all safely stored. Cooking/dining equipment and utensils were present. LPAs observed sharp objects and toxic chemicals/poisons accessible to residents, as they were not locked in the drawers and cabinets they were being stored in. LPAs observed medications labeled, as required, and stored in locked areas, however, they were pre-poured into cups. Additionally, LPAs observed medication being centrally stored that were passed their discard date. Additionally, LPAs observed clean and used syringes being stored in re-purposed food containers. (CONTINUED ON LIC 809C) (CONTINUED FROM LIC 809) No pools or bodies of water were observed on the premises. Per caregiver, no firearms or ammunition are kept at the facility. First aid kit(s) were complete and readily accessible. Required licensing postings were observed in visible areas of the facility. LPAs observed resident records not locked in the cabinet they were being stored in and accessible. Due to time constraints LPAs were unable to complete the visit and will return at a later date to conduct the remaining portion of this inspection. Six deficiencies were observed and cited during today's visit per California Code of Regulations, Title 22 (refer to the attached LIC 809-D pages). A plan of correction was jointly developed with caregiver. An exit interview was conducted with Caregiver Mariaelena Bautista, to whom a copy of this report and the Licensee/Appeal Rights (LIC9058 03/22) were provided at the conclusion of the visit.the state’s words, verbatim · CDSS document, Sep 3, 2026

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87309(a) · Plan of correction due date: Sep 14, 2026

Storage Space and Access (a)...the licensee shall ensure that disinfectants, cleaning solutions, poisonous substances, knives...sharp objects, and other similar items which could pose a danger to residents are in locked storage... This requirement was not met as evidenced by: LPAs obserevd the knife drawer in the kitchen to be unlocked and cleaning chemicals under the sink to be unlocked. This poses an immediate health and safety risk to 5 of 5 residents in care.the state’s words, verbatim · CDSS document, Sep 3, 2026

Plan of correction: Staff immedietaly removed knives, scissors, and chemicals from the drawers and cabinets that could not be locked and put them in the garage inacessible to residents in care. Staff will place a lock on the sharp drawer and chemical cabinet by POC due date.

From the deficiency page — Deficiency type: Type A · Section cited: HSC1180.4(k) · Plan of correction due date: Sep 3, 2026

...Guidelines for Behavioral, Mechanical, and Physical Restraints...(k) A person in a facility … has the right to be free from the use of seclusion and behavioral restraints of any form imposed as a means of…convenience, or retaliation by staff. This right includes…to restrict the person’s freedom of movement… This requirement was not met as evidenced by: LPAs observed R1 laying in her bed with 2 chairs preventing her from getting up. Staff reported it is to prevent her from falling. This poses an immediate personal rights risk to 1 of 5 residents in care.the state’s words, verbatim · CDSS document, Sep 3, 2026

Plan of correction: Staff immediately removed the chairs from R1's bed. Staff will do a training on personal rights by POC due date.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87465(h)(5) · Plan of correction due date: Sep 14, 2026

Incidental Medical and Dental Care (h) The following requirements shall apply to medications which are centrally stored: (5) Each resident's medication shall be stored in its originally received container. No medications shall be transferred between containers. This requirement was not met as evidenced by: LPAs observed medications pre-poured in cups locked in the medication cabinet. This poses a potential health and safety risk to 5 of 5 residents in care.the state’s words, verbatim · CDSS document, Sep 3, 2026

Plan of correction: Staff reported they would immeditely cease pre-pouring medications and keep medications in their original packaging. Staff will complete a medication training by POC due date.

From the deficiency page — Deficiency type: Type B · Section cited: CCR87465(i) · Plan of correction due date: Sep 14, 2026

Incidental Medical and Dental Care (i) Prescription medications which…are otherwise to be disposed of shall be destroyed in the facility by the facility administrator and one other adult who is not a resident. Both shall sign a record, to be retained for at least three years... This requirement was not met as evidenced by: LPAs observed 3 medications for R2 which were pass their discard date. This poses a potential health and safety risk for 1 of 5 residents in care.the state’s words, verbatim · CDSS document, Sep 3, 2026

Plan of correction: Staff reported they will discard R1's medications using the destruction log by POC due date.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87629(b)(2) · Plan of correction due date: Sep 14, 2026

Injections(b)...the licensees who...retain residents who require injections shall be responsible for the following:(2) Ensuring that ...syringes, needles and other supplies...are stored as specified in Section 87465(c). This requirement is not met as evidenced by: LPAs observed used syringes not being stored in repurposed food containers. This poses a potential health and safety risk to 5 of 5 resdients in care.the state’s words, verbatim · CDSS document, Sep 3, 2026

Plan of correction: Staff will obtain proper sharps collector containers for used syringes by POC due date.

From the deficiency page — Deficiency type: Type B · Section cited: CCR87506(c)(1) · Plan of correction due date: Sep 14, 2026

Resident Records (c) All information and records obtained from or regarding residents shall be confidential. (1) The licensee shall be responsible for storing active and inactive records and for safeguarding the confidentiality of their contents... This requirement is not met as evidenced by: LPAs observed resident records being stored in an unlocked cabinet. This poses a potential personal rights risk to 5 of 5 residents in care.the state’s words, verbatim · CDSS document, Sep 3, 2026

Plan of correction: Staff reported they will get a lock for the records cabinet by POC due date.

Type of visit: Case Management - Incident

Licensing Program Analyst (LPA) Dang Nguyen conducted an unannounced Case Management - Incident visit. LPA was welcomed by, identified himself to, and discussed the purpose of the visit with Caregiver Juliana Castro. LPA also spoke via phone with Licensee/Administrator Zayden Chen during the visit. Today's visit was in response to Licensee’s self-reported death of Resident #1 (R1), received at the CCLD San Diego Regional Office on 12/23/2025. [See LIC 811 Confidential Names List for a description of R1]. Per the report, R1 passed away at the facility on 12/22/2025. However, records and interviews of staff today showed that this was a typing error: R1 in fact died on 12/23/2025. During today’s visit, LPA performed a brief facility tour and welfare check on the one (1) remaining resident care, finding no safety concerns. LPA also collected copies of and reviewed pertinent care records. LPA interviewed relevant staff. No deficiencies were observed or cited during today’s visit. An exit interview was conducted with Caregiver Juliana Castro. A copy of this report, the LIC811 Confidential Names List, and the Licensee/Appeal Rights (LIC9058 03/22) were provided during to Licensee/Administrator Zayden Chen during the visit.the state’s words, verbatim · CDSS document, Dec 26, 2025

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Dang Nguyen made an unannounced visit to conduct a Required Annual Inspection. LPA was welcomed by, identified himself to, and discussed the purpose of the visit with Licensee/Administrator Zayden Chen. According to the facility’s license, the facility has a maximum capacity for six (6) residents, of whom all may be non-ambulatory and one may be bedridden. Per LPA observation and manager interview: During today’s inspection, there were a total of zero (0) residents in care. The facility’s license does not include endorsements for delayed-egress doors or secured perimeter doors, and neither of these were present. LPA, accompanied by the Licensee/Administrator, toured the interior and exterior of the facility, and inspected all common areas and bedrooms. LPA also reviewed the Licensee/Administrator’s personnel file. During the facility tour, LPA observed, and Licensee interview confirmed: -The facility did not have working telephone, as required. -The facility’s fire extinguisher had not been serviced within the last twelve (12) months, as required. [During today’s visit, Licensee phoned a professional vendor to make a service appointment for the extinguisher.] -The facility required cleaning and/or repair in these areas: a) The facility’s doorbell annunciator/speaker was partially dismantled and was not working; b) The facility’s electric garage door (which is a potential emergency exit route per the facility sketch) was not working; c) An electrical outlet in Bedroom #4 was missing a receptacle; d) Two (2) of the electrical outlets in Bedroom #2 were missing plastic covers; [CONTINUED ON LIC 809-C] [CONTINUED FROM LIC 809] e) A window screen in Bedroom #2 was broken; f) The sliding window screen in the Living Room was broken; g) Two (2) of the drawers in Bathroom #1 were missing pull knobs; h) Stowed inside Bedroom #6 was a non-working refrigerator/freezer combo that Licensee said was junk and needed to be discarded. -Hot water temperature at taps intendend for resident use were too hot, per regulation: Bathroom #1 Sink was 131.4 F and Bathroom #2 Sink was 139.3 F. [Regulation required these taps to be between 105 F and 120 F.] -1 of 2 bathroom showers did not have a slip-resistant mat, strip, or similar flooring, as required. -The facility had Internet service but did not have a telecommunications device at the facility which was dedicated for resident use. Pathways were free of obstruction and trip hazards. Resident bedrooms contained the required furnishings. Doors, windows, toilets, and showers were working. Extra linens and hygiene supplies were present. The facility had sufficient space and equipment to facilitate dining, laundry, visitation, meetings, and resident activities. The facility’s ambient internal temperature was complaint at 76 F. Appliances to preserve perishable food were also compliant in temperature. Cooking/dining equipment and utensils were present and in good condition. There was a locked area for the storage of client medication. Confidential records were stored in locked areas. The facility’s fireplace was screened, as required. The facility did not have a swimming pool or similar body of water. Per the Licensee, no firearms or ammunition are kept at the facility. Smoke alarms, carbon monoxide detector, night lights, and emergency lighting were working. Required licensing postings were observed in visible areas of the facility. Licensee presented proof of current business liability insurance. Since the facility currently has zero (0) clients in care, no deficiencies were cited during today’s inspection. However, LPA issued six (6) Technical Violations (refer to the LIC 9102-TV pages). An exit interview was conducted with Licensee/Administrator Zayden Chen, to whom a copy of this report, the LIC9102-TV pages, and the Licensee/Appeal Rights (LIC9058 03/22) were provided during today’s visit.the state’s words, verbatim · CDSS document, Sep 30, 2025

Type of visit: Prelicensing

Licensing Program Analyst (LPA) Ryan Fulton conducted an announced Pre-Licensing visit to observe the facility’s physical plant for compliance with Title 22, Division 6 of the California Code of Regulations and California Health & Safety Code. LPA was greeted by, identified himself to, and explained the purpose of the visit to the applicant’s representative, Administrator Zayden Chen The facility fire clearance was granted on 8/09/2024 and reflected that the facility was approved for six (6) residents in total, of which five (5) may be non-ambulatory and one (1) may be bedridden. The facility's fire clearance did include delayed-egress door and secured perimeter endorsements. The submitted facility sketch was consistent with the current layout of the facility. During today’s visit, LPA, accompanied by the applicant’s representative, toured the interior and exterior of the facility and inspected each room. The facility was clean, sanitary, and in good repair. Pathways were well lit and free of obstruction and slip hazards. Resident bedrooms allowed for easy passage and contained the required furnishings. Toilets, sinks, and showers were in working order. The facility’s ambient internal temperature was compliant at 72 degrees F. Hot water temperature at taps accessible to residents were also compliant: Kitchen sink was 107.6 F, Bathroom #1 sink was 105 F, and Bathroom #2 sink was 106 F. The facility has enough linens, hygiene supplies, cooking and dining supplies, and perishable and non-perishable food for future resident use. All kitchen appliances were in working order The facility has sufficient space and equipment to facilitate laundry, visitation, meetings, and resident activities. The facility has locked areas for storage of sharp objects, medication, and confidential resident and staff records. No pools or bodies of water were observed on the premises. There were no toxic chemicals/poisons, fireplaces, or open-faced heaters accessible to residents. Per the applicant’s representative, no firearms or ammunition are or will be stored at the facility. Smoke alarms, carbon monoxide detectors, emergency lighting, and facility telephone were all operational. All fire extinguisher(s) were serviced within the last twelve months. A complete first aid kit was present. Required licensing postings were observed in visible areas of the facility. The items reviewed were complaint with Title 22, Division 6 of the California Code of Regulations and California Health & Safety Code. The applicant passed the pre-licensing inspection. LPA also provided the Component III Training during today’s visit. Administrator Zayden Chen was advised that the facility’s application is pending management final review and approval. An exit interview was conducted with the applicant’s representative Administrator Zayden Chen, to whom a copy of this report and the Licensee/Appeal Rights (LIC9058 03/22) were provided during the visit.the state’s words, verbatim · CDSS document, Aug 29, 2024

Type of visit: Office

Component II completion: Successful Facility Type: RCFE Application Type: CHOW Capacity: 6 Census : 4 Method: Telephone call with CAB COMP II Participants: Zayden Chen (Administrator/Licensee) & Tammy Edwards (Analyst). Administrator/Licensee participated in COMP II via telephone call with CAB analyst. Identification of the Administrator/Licensee was verified by confirming driver’s license number. During COMP II, Administrator/Licensee confirmed the understanding of Title 22. Component II was successfully completed. Administrator/Licensee was advised to email signed LIC 809 with copy of photo ID to CAB. During COMP II, CAB analyst confirmed Administrator/Licensee's understanding of following areas: 1. Facility operation: License type, client/resident populations, and program 2. Admission Policies 3. Staffing requirements & Training 4. Restrictive/Prohibited Health Conditions 5. General provisions 6. Emergency Preparedness 7. Complaints & Reporting 8. Pre-licensing readinessthe state’s words, verbatim · CDSS document, Aug 2, 2024